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Topic: Hyperlipidemia a risk for ER+ breast cancer

Forum:
Breast Cancer with Another Diagnosis or Comorbidity — Meet others who have breast cancer but also have another health diagnosis/comorbidity such as diabetes, MS, bipolar disorder, HIV or AIDS, Parkinson's Disorder, schizophrenia, etc.

Figured I'd stop by to mention something of interest to those of us on this thread: Consumer Reports (not normally inclined to recommend meds before first trying lifestyle changes) is recommending statins even for those over 50 without heart disease or even just mildly at risk (Framingham score between 7.5-10%). And Bob (my DH, a cardiologist) just showed me a new NEJM article recommending statins as a treatment for ER+ bc—not just preventive for older women not yet diagnosed, but to lower recurrence risk and slow tumor growth for those of us already diagnosed. The same metabolic pathway (a "cholesterol metabolite") that raises LDL cholesterol also activates estrogen receptors and stimulates tumor growth. High BMI may predispose us to ER+ bc more by that process than by providing too many "hormone factories" in the form of fat cells. Guess it's time for that talk with my PCP.

Very interesting!! I've been taking simvastatin for years. High cholesterol runs in my family. Even at my lowest weight my cholesterol was borderline with medication. I would be interested to read something on this. Thanks for sharing!!

This is very interesting to me as well. I was just diagnosed with high cholesterol in December - a month before my second BC diagnosis. I was told to exercise an hour a day and change my diet to reduce my cholesterol by March or I would be put on statins. Because the BC diagnosis, I have not been following the recommendations in lifestyle to reduce my cholesterol.

If you have the references to this research, could you pass it to me? I will take it to my family doctor.

Very engaging topic, ChiSandy. My cholesterol hovered at 200's all my life, until I started letrozole. Then it zoomed up to 240's. I have resisted starting a statin because it's yet ANOTHER prescription medication to keep track of. Instead, I started red yeast rice supplements, which brought it back down, but when I'm naughty with my diet/exercise it goes right back up there.

Thanks for the update. When you have a chance, please provide a link for the recent NEJM paper you mentioned. I searched the NEJM website and could not find anything in the 2016-2017, but could easily have missed it.

As with all things breast cancer, there appear to be a variety of pre-clinical and clinical studies in this area. Consultation with a medical oncologist is probably needed to get an overview of the body research in this area. Statins are not without side effects, so if considered, a case-specific risk/benefit analysis would be conducted.

"Cholesterol-lowering medication during adjuvant endocrine therapy may have a role in preventing breast cancer recurrence in hormone receptor–positive early-stage breast cancer. We recommend that these observational results be addressed in prospective randomized trials."

I had read a similar study a few months back. However, given the reputation that statins have for causing arthralgias, I'd be leery of layering that RX on top of an AI. That issue was not addressed in the article and, indeed, the two MDs discussing the issue seemed pretty cavalier about SE of both statins and AIs, as I recall.

I found this to be an interesting observation, suggesting the type of endocrine therapy might affect potential benefit received from initiation of cholesterol-lowering medication "CLM"):

"Conversely, women treated with tamoxifen monotherapy did not appear to benefit from CLM initiation. We recognize, however, that low numbers of patients in these analyses limit the interpretation of these results."

As regards the findings of Borgquist (2017), this signficant caveat is noted:

"Although this study is based on routinely collected clinical trial data from a randomized trial, it is primarily observational. It should be noted that BIG 1-98 was not designed to specifically address the questions raised in this study."

Hence their conclusion:

"Cholesterol-lowering medication during adjuvant endocrine therapy may have a role in preventing breast cancer recurrence in hormone receptor–positive early-stage breast cancer. We recommend that these observational results be addressed in prospective randomized trials."

This is a complex situation for me being dx with hypothyroid a few years ago while on Letrozole. Hypothyroid also affects elevated cholesterol levels, glucose metabolism, blood pressure and may cause inflammation issues with joint pain. It seems like lots of symptoms over lap with AIs. PC wanted me to take statin (which would have meant 4 prescriptions plus high BP medication) but cardiologist said no because I have a very high HDL. I recently ended my AI treatments and have been waiting for my body to stabilize and find my new 'normal'. It was difficult trying to keep the cholesterol levels down but I managed to get total to 199 last checkup. Some adjustment were done to my thyroid medication a few months back and now total cholesterol back up to 225, HDL 100, LDL 114. The concern is now my HbA1c is just elevated as pre-diabetic. Some studies have shown that taking a statin when pre-diabetic stage may push some patients into full blown diabetes. So I will discuss increasing my thyroid medication back up and repeat labs before I will consider a statin. When I decreased my thyroid medication it took several months for the symptoms to return but my TSH level is going up too. I am so tired of drugs.....

I have only the hard copy, not online: NEJM, Oct. 13, 2016, with the relevant paragraph on p. 1464.

I am not looking forward to starting yet another drug that could carry unpleasant SEs (though my husband put himself on atorvastatin two years ago with no SEs other than disgustingly healthy lipid levels—and no concomitant increase in fasting glucose or a1c). I tried it once in 2013—it dramatically lowered my triglycerides & LDL, but raised my fasting glucose to 130; when I mentioned burning aches in my thighs upon exercise, my PCP dc’ed it because my Framingham risk score at the time was only 4%. But I’m four years older, 15 lbs. heavier, 18 mos. post-bc-dx, and after >1yr. on letrozole, my lipids have deteriorated to the point where I’m barely on the “good” side of the ratio; so it’s time to revisit it. (In retrospect, that burning was likely lactic acid from starting exercise after years of being deconditioned—I felt it again last month when I began working with a trainer, with no statin in the picture).

"If you have an underactive thyroid (hypothyroidism), treatment may be delayed until this problem is treated. This is because having an underactive thyroid can lead to an increased cholesterol level, and treating hypothyroidism may cause your cholesterol level to decrease, without the need for statins. Statins are also more likely to cause muscle damage in people with an underactive thyroid."

I take metformin for prevention of recurrence and have to explain NO, I'm NOT diabetic all the time. Gabapentin and Paxil for neuropathy/hot flashes, and letrozole for, well, you know. Do I want to throw in a statin? Heck no. I don't want to risk more aches and diabetes, but if it would keep the beast in the box, I'm willing to entertain the thought.

"Agents targeting signaling pathways in cancer cells are less specific than advertised. A number of these agents induce cardiovascular toxic effects ranging from decreased ejection fraction to atrial arrhythmias."

However, it was published before either Borgquist (2017) (see above) or the 2016 study posted by wallycat, both of which had limitations. wallycat's 2016 paper concludes very clearly:

"To date, there are no sufficient data to recommend statin administration routinely for the prevention of breast cancer relapse. However, further clinical studies in the future might be practice-changing."

In other words, the authors of the Sakeliakis study do not consider their results to be practice changing, and indicate that additional clinical trials are needed.

If of interest, the question of whether the available data support the initiation of statin use in any particular patient should be discussed with a Medical Oncologist.

Thanks, BarredOwl. My husband brought me the article as part of our, uh, “continuing dialogue” about statins (my philosophy is that I have enough pills to take as it is and I’d prefer not to thicken my body’s chemical soup, his is that if it were up to him he’d put statins in the drinking water for everyone over 50). Just before starting letrozole, I showed my MO an abstract that concluded that hyperlipidemia, esp. LDL-C, is a known SE of AIs, and that statins can raise blood sugar and perhaps nudge metabolic syndrome into full-on insulin resistance & Type 2 diabetes. I asked her if I should therefore also be placed on a statin to counteract that SE of letro and metformin to counteract that SE of statins. She replied that she prefers lifestyle measures to lower cholesterol & blood sugar; and that, like my flu & pneumonia vaccines, all that was in in my PCP’s wheelhouse, not hers—in fact, the blood chem panels she ordered before my Zometa infusion and later Prolia shots did not include lipids, thyroid or H&H.

My personal goal is to take as little as possible, though I do take supplements/herbs, which have their own real issues. Since there is no guarantee that taking any of it will protect me, for me personally, lifestyle and crossing fingers, plus the supplements is a mid-place I can live with. I do have prediabetes and if at some point ws told to take metformin, I would do it more willingly now rather than kill myself with dramatic lifestyle changes.

If anyone is on statins and has muscle aches/pains, take co-q10 and it should help.

Artificial sweeteners already made the “fecal scroll” a decade ago. When the brain recognizes a sweet taste, it signals the pancreas’ islet cells to pump out insulin in order to mop up the expected onslaught of sugar. When the sugar doesn’t materialize, and that insulin is all dressed up with nowhere to go, your blood sugar temporarily plummets (you get cranky, headachy, jittery &/or fatigued) and the insulin also causes the liver to release glycogen stores…but rather than have your muscles burn the glycogen, the liver turns it into fat for storage. Some artificial sweeteners are worse than others—the closer they taste to sugar, the higher the insulin spike. If you must use artificial sweetener, xylitol and stevia are the weakest in signaling insulin release.

Processed foods have increased their market share in large part because of agribusiness. In the mid-‘70-s, Ag. Sec’y Watt increased subsidies to corn (not sweet corn) farmers, and surpluses increased. Whatever corn could not be sold for animal feed or converted to biofuels or made into plastic is converted into various additives such as corn syrup (esp. HFCS), preservatives, texturizers, fillers, flavoring agents, even the urea (!) from which caffeine is produced (that’s where the vast bulk of caffeine added to drinks and drugs comes from, not from the caffeine removed by decaffeinating coffee beans before roasting).

Read Michael Pollan’s “The Omnivore’s Dilemma” to get the skinny (sorry) on this. The chapter on corn will infuriate you. It made me read a host of other books on how agribusiness and the sugar and processed food industry lobbies have corrupted not just the Std. American Diet (aka SAD) but even much of the research up till about a decade ago. Pollan, Marion Nestle & Gary Taubes are especially instructive in that regard. The onset of the obesity epidemic can be traced to the beginning of the low-fat and fat-free craze, and many dieticians and nutritionists are still citing 1950s-80s dietary philosophy influenced by these lobbies.

I don't believe you can buy margarine with trans fat anymore, although I could be wrong.

Unfortunately, processed foods, artificial sweeteners, and high-fructose corn syrup, as well as the complex and powerful and legislative lobbies of the food and agriculture industries, are going strong.

Any margarine in stick form (and some in tubs) is trans-fat, and the dairy case is full of several brands. Many cheap diners (and even airlines) serve “part-dairy spread” instead of butter. Crisco is also alive & well (though definitely making some folks unwell). The only non-trans-fat margarines are those cholesterol-lowering “spreads,” which taste awful and I have no idea how they are solid at room temperature without being hydrogenated. And I do remember SnackWells, which used all sorts of engineered carbs to make up for a lack of fat—heck, you’re better off eating a real cookie made with butter. And anyone remember chips cooked in Olestra (aka “Olean”)? The small print in ads for them mentioned “anal leakage” as a possible side effect.

Chi Sandy - i just ordered the book you mentioned - looks very interesting. It may raise my blood pressure though LOL! The SAD fast food empire has been pushed on the public for years starting way back with "TV dinners". I don't want to guess what was in those meals. Does anyone remember back when they added wood pulp/fiber to bread to make it healthy for fiber in our diet. This was back before any food or products had label ingredients. Then it was all over the news how humans cannot digest wood like a termite! Scary what the American food industry has gotten away with and continues to sell to the public.

I saw my PCP last week to discuss thyroid issues and increased my medication back up - will repeat labs in a few months. Exam was side tracked as I had a respiratory infection and needed antibiotics. I've continued to do my own research on hypothyroid to better understand and manage symptoms. Stumbled across this research.

"This study suggests that hypothyroidism may be falsely increasing the levels of the HBA1C test. While thyroid hormone therapy decreases the HBA1C test results, suggesting an improvement of blood sugar control, actual measurements of fasting blood sugars and overall glucose tolerance were unchanged on thyroid hormone therapy. This may lead to errors in diagnosing pre diabetes and diabetes in patients with hypothyroidism. This is important for both physicians and patients to know."

selizabeth - I agree with you that my thyroid issues are a result of my radiation treatments. My tumor was high up 11 oclock position near clavicle. It never occurred to me to ask for a thyroid shield like you can request during a mammogram or dental x-rays. I've come across other patients who have had radiation treatments and later had thyroid issues too.

It begs me to ask...is it the hormone affecting lab outcomes or genuinely affecting the blood values. I know aspirin can raise the a1C but again, is that affecting the lab or the actual blood values.

When I was low carbing, my fasting was back in the normal range but my a1C went up slightly. I was also doing daily 325mg aspirin. I started including more carbs and went to a baby aspirin and my fasting crept back up but my a1C went down.

Interestingly, my thyroid lab 2 years ago was at the cusp of hypothyroid and last year, it was nearly perfect. NO idea what that was about.